Ms. Tham, standing 1.7 m tall and weighing 93 kg, has a body mass index (BMI) of 32, classifying her as grade one obese. Master of Science, Doctor Tran Ngoc Van Anh, from the Assisted Reproductive Technology Center at Tam Anh General Hospital - District 8, explained that in obese women like Ms. Tham, high insulin levels in the blood stimulate the ovaries to produce more androgen (male hormones). This disrupts the development of ovarian follicles and ovulation, leading to polycystic ovary syndrome, which makes natural conception difficult.

Similarly, Ms. Huong, 41, is 1.53 m tall and weighs 60.4 kg, with a BMI of 25.8, indicating she is overweight and has experienced infertility for three years. She also suffers from chronic hypertension and is on regular medication.

At Tam Anh IVF, approximately 20% of female patients seeking reproductive health consultations present with issues related to being overweight or obese, similar to these two cases. Doctor Van Anh noted that obesity not only affects overall health, including cardiovascular and musculoskeletal health, but also negatively impacts the female reproductive system due to hormonal imbalances, metabolic disorders, and compromised cell quality. When the body has excessive fat tissue, a large amount of androgen is converted into estrogen. Abnormally high estrogen levels disrupt the hypothalamus-pituitary-ovarian axis, interrupting the signals that regulate the menstrual cycle and ovulation, thereby hindering the development and release of eggs.

Obesity also forces the pancreas to produce more insulin to lower blood sugar, which in turn stimulates the ovaries to produce more androgen. This inhibits follicle development, leading to irregular or absent ovulation. Egg quality can also be compromised as obesity creates an inflammatory and oxidative stress environment that damages egg DNA. Poor quality eggs are less likely to be successfully fertilized or may lead to implantation failure and early miscarriage. Hormone imbalances associated with obesity can also alter the structure and function of the uterine lining, reducing the embryo's ability to implant.

According to Doctor Van Anh, obese individuals also respond less effectively to assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF). Consequently, they require higher doses of ovulation-stimulating drugs and longer treatment periods. Overweight and obese women with polycystic ovary syndrome face an increased risk of ovarian hyperstimulation when using high doses of fertility drugs. They also confront potential complications during procedures such as anesthesia and egg retrieval, posing technical challenges.

Ms. Tham received counseling from doctors regarding mild ovarian stimulation and intrauterine insemination, combined with dietary changes and regular exercise to achieve pregnancy sooner. However, her ovarian follicles did not develop with standard oral medication doses. When switched to injectable medication, too many follicles developed simultaneously, forcing doctors to cancel the cycle due to the risk of multiple pregnancies.

In her second IUI cycle, doctors doubled the dose of oral medication and combined it with low-dose injections for seven days to gradually nurture the follicles. They also closely monitored for new risks of ovarian hyperstimulation. This approach resulted in one mature follicle for Ms. Tham. Doctors then used fresh sperm from her husband for intrauterine insemination. Ms. Tham is now more than 12 weeks pregnant.

An embryologist is preparing sperm before performing IUI for a patient. *Illustration: Tam Anh General Hospital - District 8*

Ms. Huong, on the other hand, needed prophylactic medication for preeclampsia and blood pressure stabilization before embryo transfer. On day two of her menstrual cycle, doctors completely suppressed pituitary-ovarian activity with medication to inhibit endometrial lesions. Chronic endometritis was also managed to create the most favorable conditions for embryo implantation. Because the patient's ovarian reserve was significantly diminished due to age, doctors had to stimulate the ovaries with a higher-than-normal dose of medication. Ms. Huong conceived on her first day three fresh embryo transfer and is now more than 12 weeks pregnant.

Pregnant women who are overweight or obese require close prenatal monitoring. Ms. Huong needs to prevent the risk of preeclampsia, while Ms. Tham faces a high risk of gestational diabetes, hypertension, and preeclampsia. Both were advised by doctors on dietary regimens to maintain ideal weight and to adhere to their prenatal appointment schedule to detect any abnormalities promptly.

Doctor Van Anh recommended that to increase the chances of conception and ensure a safe pregnancy, overweight and obese women should adopt lifestyle changes, exercise appropriately, or undergo monitored and safe weight loss treatment according to a doctor's protocol. In some more severe cases, obesity leads to androgen excess symptoms such as acne and hair loss, causing self-consciousness and stress, requiring psychological counseling from specialists.

To prevent obesity, individuals should control their portion sizes, prioritize vegetables, fruits, whole grains, and protein, while avoiding processed foods, sweets, and fatty foods. Regular physical activity, approximately three sessions each week, 30 minutes each day, should be maintained. If conception does not occur after six months of regular unprotected intercourse, individuals should seek medical examination to check reproductive function and receive weight loss counseling if necessary.

Dinh Lam

*Character names in the article have been changed